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Dental and Oral Health (Adults)

Constant irritated tongue

09/06/2008

Question:

Hello,

I have been to my dentist and my primary care physician with no help. I have an appointment with an oral surgeon soon, but I can’t be seen for another month. I have a question about some tongue irritation that I have been having. I have had a raw, irritated tongue for a few weeks now. Its mainly located on the tip of my tongue, it is red and the taste buds seem inflamed. I wouldn`t describe it as painful, just incredibly annoying. Other days, more taste buds seem swollen and the tip feels a tad better. Food doesn`t hurt it.

My dentist looked over my tongue and told me unequivocally that there was no pathology in my mouth and to not worry. (I was terrified of cancer) I have dry mouth from an antidepressant that I started taking about a month ago and kind of a hairy-like back of tongue from smoking/coffee/antibiotics.

I was looking online and saw that this could be burning tongue. I am young for it though (26, female). Is it possible to have oral candidas without the typical white patches? I saw something called hyperplastic oral candidas, which seems to present itself with similar symptoms as mine, burning and redness but no white patches. If this can go away, I would be so happy. Would you recommend my trying an anti-fungal like Nystatin? I am extremely frustrated with getting no answers. I`m not as worried about cancer, but am tired of constantly being aware of my tongue.

Thank you.

Answer:

It is unlikely that candidiasis is affecting the anterior part of your tongue. If you make an appointment with an oral pathologist, a swab of the tongue can be done to check for yeast. If the yeast is present, then it doesn't necessarily mean that you don't have burning mouth syndrome. If a course of antifungal medication does not help, this would be consistent with burning mouth syndrome, which represents a sensory neuropathy. Nystatin would not be the drug of choice, in my opinion. Clotrimazole troches seem to be more effective and have better patient acceptance.

For more information please refer to the NetWellness article on Burning Mouth Syndrome. If an oral and maxillofacial pathologist is available, he/she would be good choice for an evaluation and any additional recommendations regarding management.

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Response by:

Carl M Allen, DDS, MSD Carl M Allen, DDS, MSD
Professor of Oral Pathology
College of Dentistry
The Ohio State University